Neuroplastic Pain
Pain, our body’s alarm system
Pain serves a vital protective function in our bodies. It's like an alarm system that warns us of harm or injury, helping us avoid dangerous situations and protect ourselves from further damage. When you touch a hot stove or twist your ankle, pain signals tell you to immediately stop or change your behaviour.
Sometimes, this protective mechanism can malfunction. Just as a home security system might start triggering false alarms, your brain might start to interpret signals which aren’t actually pain signals as pain. To stick with the alarm analogy, this would be as if your home alarm system began to interpret the phone ringing as a danger signal.
Neuroplastic pain develops through a process where your brain's neural pathways begin to connect other inputs to its pain system. The brain learns that your body’s responses to normal, safe experiences represent danger, and it will trigger a pain sensation. Additionally, the brain can start to present normal sensation as painful (allodynia) or make small pains feel bigger (hyperalgesia). Just like a well worn pathway, the more often this happens, the better the brain gets at sensing and increasing pain signals.
The transformation from helpful acute pain to persistent neuroplastic often pain involves:
Fear and anxiety about pain reinforces neural pathways
The brain becomes hypervigilant, constantly scanning for potential threats, and
Stress and emotional factors amplifying pain signals
Despite being a false alarm, imaging studies have confirmed that the pain that the sufferers of neuroplastic pain feel is real.
Ending false alarms
Because neuroplastic pain is an experience which is developed within the brain (i.e., learned) the great news is that it can be effectively treated, and in many cases cured. The aim of Pain Reprocessing Therapy is to help the brain un-learn the presentation of normal and safe experiences as pain signals. To come back to the alarm system analogy, PRT lets you disconnect your phone lines from your alarm system, and lets you adjust the alarm control panel so that it only reports actual danger signals.
The Myth that Pain Must be Caused by Tissue Damage
Low back pain, (or LBP) is a common complaint - according to the WHO low back pain is the leading cause of disability worldwide. As of 2020, it was estimated to affect 619 million people around the world. Further, 90% of LBP cannot be accounted for “by another diagnosis such as an underlying disease, pathology or tissue damage” ( WHO link ) This is called non-specific low back pain.
Other chronic pain conditions are diagnoses of exclusion. For example, the diagnostic criteria for Fibromyalgia are Widespread Pain Index and Symptom Severity Scale scores combined with a time based element (3 months) and the following statement: “The patient does not demonstrate any other disorder that would otherwise explain the pain” (NIH link.) This is not to suggest for a moment that the suffering caused by fibromyalgia is not real, only that no tissue damage or structural issue can be found to explain the pain that’s occurring.
You might be wondering about an MRI result that showed a bulging disk, or disk degeneration - did you know that a systematic review in the American Journal of Neuroradiology of over 3000 patients found that amongst asymptomatic patients in their 30s - 31% had disc herniations and 52% had degeneration. Further studies referenced in the review have called into question the value of imaging in predicting the painfulness of degenerative changes. For more information, please see the original study table here.
To be clear, pain needs to be thoroughly worked up by a medical professional to ensure there are no structural causes, however, in many cases this is precisely the case.
Do I Have Neuroplastic Pain?
Unfortunately, there is no simple test that says one way or another whether or not you have neuroplastic pain. All pain feels like it’s coming from our body and this makes it hard to separate it from neuropathic or nociceptive pain - it is real pain. The good news is there is a helpful list of indicators that you can review to see if there are indications of a neuroplastic element to your pain. The following list is adapted from the appendix of The Way Out by Alan Gordon and Alon Ziv.
The following items are presented in the order they are presented in the book, and are not rank ordered in terms of likelihood.
Pain originated during a time of stress.
Pain originated without injury
Pain is inconsistent
Large number of symptoms
Pain spreads, or moves around
Pain is triggered, or worsened by stress
Pain is triggered by things that have nothing to do with your body (e.g. smells, sights, times of day, weather)
Symmetrical symptoms in peripheral locations - it’s unusual to develop pain on both sides of the body at the same time.
Delayed Pain - pain which develops after activity (that you didn’t notice during the activity)
Childhood adversity
Common personality traits:
Self criticism
Putting pressure on yourself
Worrying
Lack of physical diagnosis
If even a few of these items resonate with you, there is a good chance that you have elements of neuroplastic pain - a very treatable condition.